Provider Demographics
NPI:1295057180
Name:ELLAHI, MOHAMMED N (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:N
Last Name:ELLAHI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 SMITHTOWN BYP
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5004
Mailing Address - Country:US
Mailing Address - Phone:631-929-0280
Mailing Address - Fax:
Practice Address - Street 1:712 SMITHTOWN BYP
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5004
Practice Address - Country:US
Practice Address - Phone:631-979-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist